ACV v Public Guardian and ACX
[2011] NSWADT 167
•12 July 2011
Administrative Decisions Tribunal
New South Wales
Medium Neutral Citation: ACV v Public Guardian and ACX [2011] NSWADT 167 Hearing dates: 24 June 2011, 6 July 2011 Decision date: 12 July 2011 Jurisdiction: General Division Before: L Goodchild, Judicial Member Decision: That the decision of the Public Guardian be affirmed.
Legislation Cited: Administrative Decisions Tribunal Act 1997
Guardianship Act 1987
Guardianship Regulations 2005Cases Cited: OM v Public Guardian (2010) NSWADT 137 Category: Principal judgment Parties: ACV (Applicant)
Public Guardian (First Respondent)
ACX (Second Respondent)File Number(s): 113124 Publication restriction: s.126 of the Administrative Decisions Tribunal Act 1997 applies.
ORDERS
The decision of the Public Guardian made on 3 May 2011 that the Public Guardian accepts the high level care vacancy offered to Mrs L at the Orange Aged Care Facility (ACF) be affirmed.
reasons for decision
Introduction
GENERAL DIVISION (L GOODCHILD (JUDICIAL MEMBER)): Mrs L is a 99 year old woman (DOB 19.06.1912) who is currently residing in hostel accommodation in Sydney ("the Sydney facility"). She has 3 children, a daughter - the applicant ACV, a second daughter the second respondent ACX and a son.
Mrs L has been under guardianship since May 2000. The orders have been renewed and varied on a number of occasions. Mrs L is also subject to a Financial Management Order that was made on 7 August 2000. In a Guardianship Order dated 17 April 2008, the Public Guardian was given the authority to make decisions on behalf of Mrs L in relation to the functions of accommodation, healthcare, medical and dental consent and services.
On 3 May 2011, the Public Guardian made a decision about Mrs L. The decision was:
The Public Guardian accepts the high level care vacancy offered to Mrs L at the Orange Aged Care Facility (ACF).
On 12 May 2011, following an internal review conducted at the request of ACV, the decision of the Public Guardian was affirmed. It was noted in the internal review the following:
"Mrs L is a very elderly woman with a significant cognitive impairment, reduced mobility and impaired vision. Moving to a new facility in a new location which is unfamiliar to her, and to be surrounded by people with whom she is unfamiliar is not without some risks. However, these risks are reasonably manageable and must be considered in relation to the considerable potential benefits to Mrs L arising from the move. Mrs L will be located in a facility which is better staffed and better equipped to meet her increasing physical care needs. She will have greater access to her daughter who will be able to visit several times a week, if not daily. This will enable greater community access and access to environments to which Mrs L has a stated sentimental attachment. The balance between risks and benefits are weighed in favour of Mrs L moving to the facility in Orange."
The decision was stayed on 20 May 2011. On this day, ACX was joined as a party.
The preferred position for ACV is that Mrs L remain at the Sydney facility where it is contended by ACV "she is being properly cared for" until a vacancy becomes available in "B" which is the high care unit at the Sydney facility or she moves to a high care room at another Sydney facility.
The Second Respondent, ACX, also a daughter of Mrs L, seeks that the decision of the Public Guardian to move her mother to Orange be upheld. ACX resides in a small town near Orange.
Mrs L has a son who was also consulted for the purposes of the Public Guardian's decision and his view is recorded as being that he would be happy for his mother to leave the Sydney facility. With respect to the move to Orange, it is noted that the son had no specific concerns with that arrangement.
At the hearing of these proceedings, the Public Guardian urged this Tribunal to uphold the decision made on behalf of Mrs L that she be transferred to a high care vacancy available in Orange.
Jurisdiction
Section 80A of the Guardianship Act 1987 (' Guardianship Act ') provides that an application may be made to this Tribunal for a review of a decision of the Public Guardian that is made in connection with the exercise of the Public Guardian's functions under the Guardianship Act as a guardian, and is of a class of decision prescribed by the regulations.
Regulation 17 of the Guardianship Regulations 2005 provides that all decisions of the Public Guardian made in connection with the exercise of its functions are prescribed for the purposes of s.80A of the Guardianship Act , hence the decisions made by the Public Guardian in relation to the accommodation of Mrs L are decisions in respect of which an application may be made for review to the Tribunal.
Applicants who may apply to the Tribunal under s.80A of the Guardianship Act include the protected person, the spouse of that person, a carer and "any other person whose interests are, in the opinion of the ADT, adversely affected by the decision" (s.80A (2) (d)).
I accept that ACV falls within that definition as being a daughter of Mrs L and her interests could be adversely affected by a decision and she is therefore able to apply to this Tribunal for review of the Public Guardian's decision.
In conducting the review, it is the role of this Tribunal to conduct a merits review to determine whether the Public Guardian's decision that Mrs L be accommodated at Orange and not at her current accommodation in Sydney is the correct and preferable one having regard to the material before the Tribunal including any relevant factual material and any applicable written or unwritten law (s.63 of the Administrative Decisions Tribunal Act 1997 ). In making its decision, the Tribunal is to have regard to the principles set out in s.4 of the Guardianship Act as follows:
4 General principles
It is the duty of everyone exercising functions under this Act with respect to persons who have disabilities to observe the following principles:
(a) the welfare and interests of such persons should be given paramount consideration,
(b) the freedom of decision and freedom of action of such persons should be restricted as little as possible,
(c) such persons should be encouraged, as far as possible, to live a normal life in the community,
(d) the views of such persons in relation to the exercise of those functions should be taken into consideration,
(e) the importance of preserving the family relationships and the cultural and linguistic environments of such persons should be recognised,
(f) such persons should be encouraged, as far as possible, to be self-reliant in matters relating to their personal, domestic and financial affairs,
(g) such persons should be protected from neglect, abuse and exploitation,
(h) the community should be encouraged to apply and promote these principles.
Evidence
In determining this application, I have had regard to the following material.
For the applicant, submissions filed 3 June 2011 containing an Asset Summary for Mrs L; the decision of OM v Public Guardian (2010) NSWADT 137; two (2) Fact Sheets from the Australian Department of Health and Aging; Accreditation Decision of the Orange facility Residential Aged Care Facility of April 2009; material from Killara Gardens; s.4 of the Guardianship Act ; and an email dated 2 June 2011 from Ambulance Service of NSW. The applicant sought an opinion from Dr Lana Kossoff and tendered a report dated 14 June 2011. Dr Kossoff is a psychiatrist and has worked in aged care psychiatry for a number of years. She assessed Mrs L at the Sydney facility on 8 June 2011.
The first respondent relied upon documents contained in a folio paginated from 1 to 170 containing the Limited Guardianship Order from 2005 and 2008; the Decision of the Public Guardian of 3 May 2011; the Reasons for Decision Report dated 3 May 2011; and Internal Review Decision dated 12 May 2011. The documents relied upon by the first respondent also include numerous pieces of correspondence from the Sydney facility from the second respondent; from the Orange facility and other file notes being notes of conversations and phone calls made to or from the Public Guardian.
The documents relied upon by the second respondent include what is referred to by her as an Affidavit dated 10 June 2011 annexing a schedule of visits by the her marked "A"; photographs of her mother age almost 96 during her short holiday visit to her property in 2008 marked "B-I" and "B-II"; a recent photograph of her mother's cottage on the property marked "C"; and a 1998 photograph of a section of a 1.5 km sweep of Golden Ash trees planted in 1980 by her mother along the Mitchell Highway marked "D".
The applicant called Ms D, the general manager of the Sydney facility, to give evidence. Dr Kossoff gave evidence and was available for cross-examination on behalf of the applicant. The applicant herself gave evidence and was subject to cross-examination.
The first respondent Public Guardian tendered and relied upon a report from Dr Christopher Mah dated 2 July 2011. Dr Mah was the aged care psychiatry medical officer at the Sydney facility. Dr Mah is Mrs L's treating psychiatrist. He gave evidence and was cross-examined.
The Second Respondent called Ms CP, the clinical director at the Orange facility and Ms CM the facility manager at the Orange facility to give evidence. The second respondent herself gave evidence and was cross-examined. There was also correspondence from the second respondent to the Tribunal dated 22 June 2011 being a 2-page typed document re accessibility of psycho-geriatricians in Orange and at the Orange facility ACF specifically.
Ms JL, the nursing unit manager at the Sydney facility was called and also cross-examined.
On the final day of the hearing, the NSW Trustee and Guardian tendered a facsimile from the Sydney facility dated 30 June 2011 enclosing Mrs L's daily schedule at the Sydney facility; a file note of 1 July 2011 of a telephone call with Ms JL regarding the schedule at "B"; and a file note of 1 July 2011 of a telephone call with the Ambulance Service, Acting Patient Transport Manager.
It was common ground at the hearing that Mrs L must move from her current accommodation which is a hostel like low-care facility to a high-care facility. The reasons for this removal was because in the opinion of Ms JL, that opinion contained in a note of a conversation with the Public Guardian, that Mrs L seemed to be deteriorating and is needing more intensive care in her current room.
In April 2011, it was proposed that Mrs L move to another room in "B" with high-care facilities. At that stage it was understood and accepted by the family that Mrs L had to move to a high-care facility. However, the family were unhappy with the room proposed and further, the applicant, in April 2011, advised the Public Guardian that she would not be able to visit her mother if she was moved to the high care room in "B" because of her, being the applicant's, disability. As a result, Mrs L remained where she was and the room then available in "B" was taken by somebody else.
The applicant has subsequently ascertained that arrangements could be made for her to visit her mother in "B" notwithstanding her disability, by her mother being brought to a sitting room in "B". As such, the applicant's position at the hearing is that she supports her mother remaining where she is and then moving to "B" when a vacancy became available. The reasons why she was of this view because of the following:
(a) that the continuation of existing medical and personal relationships including familial relationships would be adversely affected by the move to Orange,
(b) that Mrs L's health would be adversely affected by the physical transfer to Orange
(c) that the physical benefits of the Sydney facility exceed those of the Orange facility.
(d) that the removal to Orange would cause anxiety, disruption and disorientation.
There is a suggestion by the applicant that if Mrs L did move to the Orange facility in Orange that it may require a second move in 2 years' time due to the further upgrading or relocation of the Orange facility upon the building of a new facility. The evidence with respect to the timing of an upgrade of the Orange facility was speculative and vague in the circumstances. As a result, I do not consider that issue a matter that properly requires consideration in these proceedings.
The evidence disclosed that in 2011, Mrs L had had two falls and one of those falls had resulted in her receiving a 20 cm laceration to her leg. This laceration needed 13 stitches. This was as a result of a fall that occurred on 27 February 2011.
Ms D, the General Manager of the Sydney facility agreed that Mrs L did need high care and she stated that the staff were managing Mrs L's needs adequately at the moment. She further stated that Mrs L had been given high care for some time and that that would continue. Ms D indicated that she was not able to be certain when a vacancy would become available at "B"; that such an assessment is difficult; that all patients there have complex health needs; all the residents there are currently stable, but the availability of a vacancy at "B" effectively depends upon the residents and their deterioration. Ms D indicated that the facility where Mrs L currently is located requires doors to be closed in comparison to the facility at "B" where there is more close monitoring with doors open. She indicated that people of Mrs L's age have a high risk of falls, that there is no difficulty in providing the care that Mrs L needs at the moment, but certainly as soon as something comes up in "B" in the high care facility she should be moved. Ms D indicated that there are common staff between the current facility where Mrs L is and at "B", although the staff are on a 3 month roster and there are some staff at "B" who are specialist staff. Ms D indicated that there would be some staff that Mrs L would be familiar with should she move to "B", but not all staff. Ms D indicated that the diversional therapist was divided between "B" and the Sydney facility.
Ms Phang for the first respondent, in cross-examination of Ms D, put to Ms D that Ms JL the nurse unit manager who was familiar with Mrs L, informed the Public Guardian in May 2011 that Mrs L had high care needs such that she was too frail to remain in the current facility and it was not safe. Ms D responded that at that time it was agreed that she had had a nasty fall and that since then she has been monitored without incident, and that it can change from day-to-day. Ms D agreed that the risk of fall in her current facility was higher than in a facility where doors could be opened and that monitoring would be better were the doors are open.
Ms Phang enquired of Ms D what furniture or personal possessions Mrs L could take with her to "B". Ms D responded that residents cannot take anything except perhaps a chair, no china cabinet or big tables because adequate room is required to undertake care of people with complex care needs. Ms D responded that this is assessed effectively for safety. Ms D indicated that Mrs L could have a television but not a large screen. Ms D acknowledged that both the applicant and the Second Respondent visited Mrs L, and were well known to the staff. Ms D in cross-examination by the Second Respondent agreed that the high care facility is more ideal for Mrs L because, for example, door frames are much wider and that it is managed at the moment in the current facility if Mrs L waits for staff.
Mr McPhee for the applicant enquired of the reasons why Ms D thought Mrs L should remain at her current facility. Ms D noted the fact that Mrs L is a local person, that she loves going to the sing-alongs, that she has been at the facility for a long period of time and that the Sydney facility mission and values is to retain people for as long as they can. She noted that changing an environment for persons in Mrs L's condition could cause further disorientation. Ms D maintained that they could continue to manage Mrs L's care in the current facility if required in the foreseeable future.
Dr Kossoff gave evidence and was subject to cross-examination. Dr Kossoff opined that she was aware that there were difficulties recruiting for psycho-geriatricians at Orange. In her oral evidence, she expanded on the opinion given in her report and stated that if Mrs L was to move that early intervention would be essential, that persons not acquainted with Mrs L may not be aware of a change in an emotional or psychological state. Dr Kossoff was of the view that there was a risk of a relapse of a depressive illness which may not be managed by pharmaceutical means. Dr Kossoff was of the view, based upon her consultation with Mrs L for the purposes of her report, that Mrs L was unable to provide consistent answers, that she was highly suggestible and that she had significant cognitive dysfunction, that she certainly had the ability to make social banter but she felt that she had no conceptual understanding.
In her report Dr Kossoff expressed the opinion that Mrs L would not have the cognitive capacity to understand the nature and effects of the comments she has made regarding her future residential accommodation. Dr Kossoff supported Mrs L going into "B" when it became available because of the higher staff to patient ratios and open doors. She considered that the move to any new location would be likely to cause a significant deterioration to Ms L's degree of orientation. She noted that Mrs L did not have any active symptoms of major depression but noted that in elderly patients psychotic depression tends to be a relapsing illness and Mrs L would require continued close monitoring.
Dr Kossoff opined that the move to "B" would be a "short move down the corridor" where Mrs L would be cared for by familiar staff and partake in meals and activities in familiar surroundings. It should be noted that the evidence in these proceedings did not necessarily support the observation made by Dr Kossoff that the move to "B" was a short move down the corridor or that Mrs L would be cared for by familiar staff or would partake in meals and activities in familiar surroundings.
Dr Kossoff was of the opinion that Mrs L should remain at the Sydney facility. She stated that while Mrs L currently has no active symptoms, she would need to have continuing close monitoring by psycho-geriatricians to prevent any relapse, to be cared by staff who are familiar with her and can easily spot a potential relapse of her depressive illness. She believed that a move to any new location would be likely to cause significant deterioration in her degree of orientation. Dr Kossoff agreed that regular visits by the second respondent would reduce any risk of distress or disorientation.
Dr Mah, the aged care psychiatry medical officer at the Hospital located near the Sydney facility and Mrs L's treating psychiatrist, noted in his report of 2 July 2011 that when he had seen Mrs L in June 2011 that since his last review in April 2011, that she had further deteriorated both physically and mentally. He noted that she appeared physically weaker and was deconditioned. He noted: " that due to the nature of Mrs L's dementia any move to an unfamiliar environment is likely to cause some degree of distress. However, it would be prudent to point out that this could as easily occur when moving to another unit within the same facility or to a facility hundreds of kilometres away. A degree of disorientation is not unexpected but this is likely to be temporary and can usually be managed by a combination of pharmaceutical and non-pharmaceutical measures ".
Dr Mah further opined that any possible disturbances will need to be weighed in relation to possible benefits such as potentially greater contact, stimulation and interaction between Mrs L and her family. Dr Mah in both his written report and in oral evidence referred to research with respect to the import of even small amounts of regular physical activity significantly improving cognitive and behavioural outcomes in patients suffering from dementia.
Dr Mah opined that from a medical and psychiatric perspective, he did not believe that moving Mrs L would be seriously detrimental and that the decision would need to be based on expected benefits. He was unable to give an opinion as to whether or not a move would be what Mrs L would have wanted.
Under cross-examination, Dr Mah noted that Mrs L was not so frail that she could not be moved, that for the period of moving that she will be likely sitting down and would sleep for most of it. He noted that any sort of move can have some risks but that those risks were not necessarily not unmanageable.
With respect to his opinion as to the pros and cons of moving Mrs L from a single room to a shared room, he noted that it would be unfamiliar for her, he could not say if it would cause her distress but he noted that she gets on well with other people. He noted that if people are disruptive it could be unsettling for her, and in his experience he has seen people who would prefer to be on their own, but he could not say whether she would necessarily prefer that. He indicated in cross-examination that it was hard to say with any confidence that she would necessarily deteriorate and that the benefits should be weighed up with the potential risk.
In cross-examination by Mr McPhee, when asking Dr Mah to comment on Dr Kossoff's opinion, Dr Mah opined that it was difficult to be absolute on one side or the other as to the likelihood of deterioration or discomfort from a move. Dr Mah stated that the risks are unpredictable, that they can be managed and monitored. He stated that he would disagree with Dr Kossoff because it is not possible to be absolute and that in this case that there may be are benefits to the move because of the other related benefits. He considered that any sort of change is unpredictable.
In his report, he stated that overall from a medical and psychiatric perspective, he did not believe that the move would be seriously detrimental.
Findings and Reasoning
For the reasons that follow, I affirm the decision of the Public Guardian dated 3 May 2011 to accept the high level care vacancy offered to Mrs L at the Orange facility.
I accept the evidence that Mrs L has been residing at the Sydney facility since 2000 and the clinical recommendations made by those caring for her at the Sydney facility that Mrs L needs to be transferred to a facility to provide her with higher care.
I accept the evidence that the current facility has been coping with her current care needs. Mrs L requires two people to assist her in dressing and undressing, washing, showering and peri-hygiene and night routine and walking and the additional staffing being allocated to her means that her welfare and interests would be best served if she moved to a high care facility.
A high care facility in Orange is available to her immediately and it is my opinion that her welfare and interests will be best served if she moved there without delay.
In making that decision, I have considered the risks involved in such a move and balanced those risks with the potential detriment of such a move.
I will now address the specific concerns raised by the applicant in her opposition to the Public Guardians decision.
The continuation of existing medical and personal relationships including familial relationships.
One matter raised by the applicant, and referred to by Dr Kossoff, against Mrs L moving from the Sydney facility relates to a familiarity of staff. The evidence discloses that the "B" staff are rotated every 3 months. The evidence discloses that the staff at the Orange facility are constant with both permanent staff and causal staff.
If Mrs L moved to Orange, she would be required to see a different general practitioner, a different dentist and a different psychiatrist. Arrangements are proposed that her current reflexologist and physiotherapist to be retained should Mrs L move to Orange. The physiotherapist and reflexologist are, in terms of treating professionals, the ones that see her currently on a regular basis.
Dr Mah has seen Mrs L on three occasions and in cross-examination noted that he took over from Dr Williams last year as Mrs L's treating physiatrist and he observed no disruption to Mrs L by that change.
The move of Mrs L from Sydney to Orange, according to the evidence of the applicant, is that she will not be able to visit her mother as frequently. The applicant gives evidence that currently she visits her mother 3 to 4 times a week. The applicant suffers from a disability which impacts on her ability to visit her mother with any greater frequency and provides a physical constraint on the areas where she can visit her mother. The applicant gave evidence that she had visited the facility in Orange and that she would be able to physically attend that facility, but the concern raised by the applicant appears to be related to her accommodation needs when she would visit Orange. The applicant did not submit that she would be unable to visit her mother should her mother move to Orange and I am not convinced that the difficulties associated with her accommodation needs are insurmountable.
The second respondent indicated that she would be able to visit her mother virtually daily.
The evidence is that Mrs L's son would be able to visit her, and he is unable to visit her now at her current accommodation.
Mr McD, a close friend of Mrs L, has been visiting Mrs L regularly for many years and he would be able to continue to do that if she resided in Orange.
The second respondent gave evidence as to Mrs L's longstanding association and involvement with the community in Orange due to her ownership of a property for many years in the region. The second respondent gave evidence that the move to this facility will enable greater community access and access to the environments which the evidence discloses Mrs L has a sentimental attachment.
On balance I find that Mrs L's immediate care and welfare needs outweigh the impact of the move on the ease of attendance on her mother by the applicant.
The physical benefits
Moving to Orange would require Mrs L to be a resident of one in a room of four (4). Upon a move to "B", Mrs L would have her own room. Dr Mah's evidence discloses that this may cause some initial discomfort for Mrs L, that this could be managed and further that some individuals prefer this arrangement as it promotes greater interaction and is less socially isolative than residing in a single room. Dr Mah gave evidence that Mrs L got on well with other people.
The staff at the Orange facility gave evidence that a movement from a low care facility to a high care facility often requires a movement of residents to shared accommodation. The staff stated that it can take residents some time to settle in, that some do adjust well as there is less social isolation and for others it can be more difficult as it represents a loss of independence.
The second respondent gave evidence that the diversional activities offered at the Orange facility are greater and more suited to high care residents than those that are currently offered at "B".
The evidence discloses that Mrs L's mobility is worsened, that currently she is not being walked, that she is using a wheel chair. Dr Mah in his report noted that Mrs L appeared weaker and deconditioned. The evidence disclosed that the Orange facility placed importance on the mobility of residents by walking residents to activities, to showers and provided walking programs.
The applicant raised a concern with the patient to toilet ratio at the Orange facility was below that as required by Australian Department of Health and Aging. Evidence was given that the patient to toilet ratio at the Orange facility was 1:6 which was in the range.
The physical transfer to Orange
With respect to any physical risk of the actual move itself, Dr Mah opined that whilst Mrs L is frail, she is not too frail to cope with the move and the evidence discloses that the move would be arranged by way of road transport with an ambulance.
The evidence discloses that a change of environment for the elderly in circumstances such as this where there is both dementia and history of depressive illness could cause emotional disturbance and instability. Dr Mah's evidence is that if this does occur, this can be managed and the evidence discloses that there are psycho-geriatrician services available in Orange who will provide triage of Mrs L upon her arrival at the facility and subsequently.
Contrary to the evidence of Dr Kossoff, the staff from the Orange facility that gave evidence confirmed the availability of 2 psycho-geriatricians in the Orange area. Evidence was also given that upon Mrs L's transfer to the Orange facility that she could be immediately assessed by a team referred to as 'SMOPS', this team is said to be specialist mental health team available at Orange.
The second respondent has indicated that she would make herself available to accompany her mother for the whole distance and to attend on her mother daily to both monitor her mother in terms of her mother settling in and also with respect to any emotional or psychiatric disturbance that may eventuate.
In exercising the Tribunal's function under this Act, I have had very close regard to the general principles, specifically principle 4(a), the paramount consideration of the welfare and interests of the person affected. I have also had regard to principle 4(e) the preservation of family relationships.
I have further had regard to principle 4(d) the views of Mrs L with respect to the move. The Public Guardian notes in its Reasons for Decision Report that when the officer responsible met with Mrs L in April 2011, Mrs L expressed that she was quite happy with the thought of being nearer to her daughter ACX, that she liked Orange very much and thought that it would be nice this time of year. ACX reports that her mother expressed to her preparedness to move to Orange. ACV reports that her mother said to her "I do not want to go". Dr Kossoff's evidence was that Mrs L at the time she saw her was unable to provide consent to anything more than simple questions. Given the nature of the evidence, I unable to determine with any resolve, the views of Mrs L.
It is uncontested in these proceedings that Mrs L, a 99 year old woman with cognitive impairment, has care needs that have increased to the extent that her needs can no longer be adequately met in a low care facility and she requires access to a high care facility. Whilst the current facility in which she resides are adequately caring for her and meeting her needs at present, this is not sustainable in the long-term. The evidence discloses that Mrs L has had 2 falls this year. A room is available immediately at a high care facility in Orange which would properly and adequately meet her current and future needs.
There are risks associated with a move to Orange including those referred to being physically moving Mrs L by way of ambulance, moving Mrs L into a facility which she will be sharing with 3 others as opposed to a single room, and a risk of disorientation by removal of Mrs L to a new environment. On the evidence before me, it appears that the risks identified are reasonably manageable and must be considered in relation to the considerable potential benefit to Mrs L arising from the move.
Mrs L will be located in a facility which is staffed to meet her current and increasing physical care needs, she will have greater access to her daughter who will be able to visit her several times a week if not daily and whilst it may be that her daughter in Sydney is not able to visit her as often as she is currently, the care and welfare benefits and the potential greater community access outweighs this concern.
I would expect that prior to any move of Mrs L to Orange that the Public Guardian would make all necessary arrangements with respect to the liaison and coordination of medical practitioners and psycho-geriatricians both in terms current care needs and medical records.
I would further expect that the SWOPS team would be advised of Mrs L's arrival at the facility and be available for immediate triage.
Order
The decision of the Public Guardian that the Public Guardian accepts the high level care vacancy offered to Mrs L at the Orange Residential Aged Facility be affirmed.
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Decision last updated: 12 July 2011
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